Abstract Body (Do not enter title and authors here): Background: Circulating myocardial injury and inflammatory markers are used to aid risk stratification in patients with suspected acute coronary syndromes (ACS), but their relationship to specific coronary plaque characteristics, including high-risk plaque features is poorly defined.
Hypothesis: We hypothesized that key prognostic biomarkers in patients with suspected ACS are associated with distinct coronary plaque phenotypes, using Coronary CT angiography (CCTA)–derived quantitative measures including non-calcified low-attenuation plaque (LAP) volume and 1k-plaque volume.
Methods: We included 484 patients from the WESTCOR trial presenting with suspected non-ST-elevation ACS (NSTE-ACS) without myocardial infarction. Coronary plaque was analyzed using semi-automated CCTA software. Circulating biomarkers included high-sensitivity cardiac troponin T (hs-cTnT), high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro–B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and growth differentiation factor-15 (GDF-15).
Results: A doubling of CRP concentration predicted LAP volumes above the median both vs. no LAP (OR 1.32, 95 % CI 1.12–1.56; p = 0.001) and vs. below-median LAP (OR 1.25, 95 % CI 1.07–1.46; p = 0.006), independent of conventional atherosclerotic risk factors (Table 1). CRP was not associated with stable plaque features, including calcified plaque volume (OR: 1.12, 95% CI: 0.96- 1.03, p = 0.158) or 1k-plaque volume (OR: 1.05, 95% CI: 0.91 – 1.20, p = 0.527). In univariate analyses, hs-cTnT, hs-cTnI, GDF-15, and NT-proBNP were associated with all plaque volume subtypes compared to patients without coronary plaque. However, these associations were lost after adjusting for conventional cardiovascular risk factors, suggesting an indirect relationship between these biomarkers and coronary atherosclerosis.
Conclusion: In patients with suspected acute coronary syndromes, increasing CRP concentrations are associated with greater coronary atherosclerotic volume and high-risk plaque features, including LAP, independent of traditional atherosclerotic risk factors. While the overall prognostic value of CRP is modest, it may reflect high-risk atherosclerosis which is not directly mirrored by other biomarkers.